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Monday, August 8, 2011

Comprehensive Rural Health Project, Jamkhed

By: Molly

A year ago, I first heard about the Comprehensive Rural Health Project in Jamkhed, India, while searching an online database of international healthcare internship opportunities. My initial online research about CRHP, consisting of a collection of YouTube videos, a national geographic article, and an extensive website (http://jamkhed.org/) soon grew into a deep admiration for what I found to be one of the most developed community healthcare projects for underprivileged worldwide.

In 1970 Mabelle and Raj Arole established CRHP with the goal of empowering local villages to uplift their status and wellness through education and health training. In an online video (http://jamkhed.org/AboutUs.shtml) Mabelle explains the Arole’s unique outlook on medicine that has been the key to their success; doctors cannot be the sole keepers of medical knowledge. While some specific medical procedures require a physician, the majority of medical knowledge should be put into the hands of the people that utilize it. Because village healthworkers are community members, they can easily relate to the issues their neighbors face. Their lessons about infection, vaccination, and water sanitation are more freely accepted. Through education and training, community healthworkers can spread their knowledge and transform their community’s overall wellbeing.

This message is no news flash to the world of medicine and public health. Names like Paul Farmer and the term “village healthworker” are now sputtered throughout medical school hallways almost as commonly as Watson, Crick and the genetic code. But, seeing one of these systems in its raw and unglorified fashion- beyond the realm of YouTube and shockwave- was a completely different experience. After arriving in Jamkhed today, I am even more starstruck than I was a year ago by the vision of the Aroles.

This afternoon I toured the CRHP Hospital at the side of Ravi Arole. Ravi, the son of Mabelle and Raj, now helps run CRHP alongside his sister Shobha. I look up to the Aroles like movie stars; awed and humbled by their accomplishments. However, while I was led through CRHP’s hospital by Ravi, it felt like I was with an uncle, much less a movie star. He is casual, kindly answers all of my pestering first-year medical student questions, and he is extremely open about the realities and hardships that CRHP has faced over the years despite their success within their project villages. This all-inclusive and equity based attitude is a main theme at CRHP, and is one of the many things that have helped their project thrive.

Ravi toured us through most of the hospital’s facilities, including three huge operating theatres, a labor and delivery room, an ophthalmology clinic, an ultrasound room, and an extensive inpatient ward. What impacted me more than the extent of the hospital’s facilities though, was one specific patient’s story.

Before entering the ward, Ravi explained that 3 of their current patients are survivors of severe burns. They are victims of domestic violence, the type I had only read about in books. It’s not easy to read about this type of violence, and even though I know it exists, there is always a shifty little way that my mind manages to rationalize these situations. I end up convincing myself that people in the world are out there solving these problems…that things must be getting better. Seeing this patient forced my dubious conscience to face the hard truth.

We walked into the ward and saw a very small 20 year old woman crouched over her bed. Her entire body including her head was covered by a shawl, but when she turned we could see the layers of scaring covering her forehead down to her neck. Ravi explained that her mother-in-law had dowsed the girl’s body in kerosene, burning 2/3 of her body. It wasn’t clear what provoked the attack, but 2 other women had suffered similar consequences from their mother-in-laws. This type of violent relationship between mother and daughter-in-law is not uncommon. Women are often punished for lack of fertility, money, and especially inability to produce a grandson.

Against some common practices, the burn victim decided to continue living after the incident in order to look after her children. She has been abandoned by all family members, including her husband. Since December, she has resided in the hospital to make her recovery with the help of CRHP staff.

Scarring over her face, arms, and hands has caused the skin to retract and makes it difficult for her to straighten her neck or use her hands. Operations at CRHP have relieved some of the discomfort. One of the students is now working with the woman, teaching her to draw pictures which she proudly showed us. After some convincing by the CRHP staff, her husband has decided to come to the hospital and help care for her. Because she has nowhere else to go, she will remain in the care of her husband and will most likely return to the home of her mother-in-law.

I realize how plainly I am describing this case, but I really have no other way of expressing how unjust the situation is and how angry I feel not only at the family who abused this woman, but at myself for not fully accepting the scale of injustice that exists within these villages. This is the reality that the village women face. While a physician can heal burns and relieve pain, only a more comprehensive health program that considers the more complex social aspects of a villager’s health, can create lasting positive change.

I may be coming to grips with this theory now, but the Aroles have been at it for over 40 years. They understand that in order to create sustainable change, problems must be tackled at their roots. This does not happen overnight or even over a year, but with time the Aroles have empowered villages to establish their own systems of social and medical support. In 1970 they came to Jamkhed as two outsiders with the courage to take action and start making change. Today, they have significantly reduced infant mortality and tuberculosis rates, de-stigmatized HIV and leprosy, and built a sustainable village healthworker training program which people from all over the world come to learn from.

Watching CRHP’s system in action and hearing their story reminds me of a quote Dr. Chandy told us in Vellore: “I am only one. But, I am one. And I will not let the things I cannot do prevent me from doing the things I can.” Like the Aroles, we can take action too. As I get ready to pack my bags for the US, I know my perception of medicine has changed, and I will no longer let myself be convinced that someone else is out there solving these problems. This is our generation’s turn to make a difference. By following the example of CRHP and the many other projects that utilize a comprehensive health model, I believe that we can succeed.

(sorry for the lack of photos and any sort of visual excitement...my camera chord is in the US in a storage unit...pics to follow)